Lots of people seem to assume my aversion to car ownership is extreme and I seem to have succeeded in giving the impression that I’m a lot more hardcore than I actually am. So, score! A couple of days ago a random man on the street in Sechelt who saw me cycling proceeded to yell at me, “OVERACHIEVER!” (little did he know I’m a med student!) However, flattering as these assumptions may be, I feel like I should rectify a few misconceptions.

Most importantly: having my bicycle as my primary mode of transportation does not mean that I will ride it 20 kilometres uphill through snow while shards of ice falling from the sky pelt my face and baby cougars nip at my feet. #carfreeclerkship does not mean I am going to bike 100% of the way, 100% of the time. There are other ways to get to work, in this likely scenario and other circumstances, namely: taking the bus, walking, private jet, batting my eyes at people who have cars.

My preferred alternative is public transit. I remember a conversation with a friend of a friend who was headed to Vancouver Island to camp on a weekend that the forecast called for rain. Thinking that rain = misery and slippery roads = scariness, and having heard him say he was going to be short on time, I asked if he’d thought about putting his bike on the bus to get to the Horseshoe Bay ferry, at which he scoffed and said “that would be cheating”.

Please.

These performances of self-sufficiency/self-aggrandizement, glorification of individualism and scoffing at a wonderful public service and efficient mode of transportation are tiring a world in which we are all, beyond any argument, interdependent. I wanted to ask him if he also welds his own frames and grows and harvests his own rubber for his tires and tubes. You see, I use single-origin organic steel with a minimum 80% Fe-56 content that I extract by hand from the depths of the Earth. Oh and I only inflate my tires by mouth because bike pumps are cheating too.

On an oppressively hot, sunny Sunday morning last summer, I showed up at a venue across town to help friends clean up after a magnificent party they’d thrown the night before. Of course I didn’t bike there. My nausea and dehydration and my need to listen to Right Round on repeat (because it was a fun evening) were not compatible with cycling 10km up a hill in the heat. One of their helpers, likewise an enthusiastic cyclist, said something to the tune of, “well that must have been a nice treat to take the bus” and I wanted so badly to say that a nice treat that morning would have been to sleep more than 4 hours, preferably while someone administered parenteral fluids and Gravol. Public transit is a public service, and by definition a public service cannot be a luxury. Even for dedicated cyclists. And don’t even get me started on the elitism/ableism in looking down on people who aren’t able to cycle everywhere they need to go, all the time.

I post about my #carfreeclerkship adventures for many reasons including: because I was frustrated with the near-universal expectation that I would own a car, because I want to challenge the assumption that driving is the default. Because it brings me joy that far outweighs the inconveniences (and there is some inconvenience if we’re being honest). Because frankly, I think we all need to be thinking about how to live with greater reliance on each other and less on fossil fuels. Because I needed inspiration and I knew I wasn’t the only one.

If my comment section had any kind of measurable traffic whatsoever I’m sure sooner or later I would hear something like, “well she accepted a ride from a preceptor once because she didn’t feel like riding 20 minutes down an unlit highway at 11 o’clock at night (true story btw) so is the #carfreeclerkship tag really accurate, hmm?” Actually yes it is, in that I still don’t own a car. I know that if I did, I would drive much more than the occasional times I do now by carpooling, or using a carshare, or whatever. All my friends have had this experience; it just becomes too easy. And because they’re so rare, I really relish the rides I do get. My BFF offered me a ride once that was completely out of her way, even though there was a perfectly convenient bus option and I had time, because she could tell I was drained of all energy. Another friend drove me home when I was supposed to be the one helping him, because he wanted to give me a break from the slushy misery of Dec 2016 in Vancouver. These are the things I remember.

In conclusion? I think being flexible about how I get around has made living with my decision to avoid car ownership much easier. I think not giving ourselves options for dealing with extenuating circumstances is a great way to ensure we don’t stick with the decision in the long-term. Most of all, I am hoping that instead of thinking “she’s so hardcore!” people will look at me and think, “she’s not that hardcore but she manages anyway; I bet I could do it too.” 🚲

“You might feel like there isn’t a lot of love in your life right now, but that is both temporary and inaccurate, because apart from those of us who may be distant but love you infinitely, if you take a look around you, you’ll see that love is in fact everywhere.”

TIL: breaking up with someone you daydreamed about having kids with, while on an obstetrics rotation, is highly contraindicated. HIGHLY. But on the bright side: I can pretend I’m crying tears of joy and not grief, and no one on my team asks too many questions.

I wanted to write down some thoughts on clerkship at the end of my first week of Pediatrics, but, well I was on call 3 nights in 7 days and had a busy social schedule thereafter (that’s right! I have a social life! Probably more so than I had before clerkship to be honest, because I’m a lot more aggressively prioritizing it. I have plans almost every evening that I’m not on call.) I mostly wanted to write down what surprised me, and now I’m worried that I’ve already started to take things for granted that were totally new just a few weeks ago…

They say learning in medicine is like drinking from a fire hose. I say clerkship is like chugging Gatorade on a hot summer’s day when you’re thirsty during a strenuous bike ride. It’s kinda overwhelming because your heart’s pumping and some degree of spillage is inevitable, but you also kinda want to look like you can handle it in front of the people (or person) you’re with even though you can’t really. But most of all, the sugar and electrolytes and water replace what you don’t even realize you’ve been missing, and they produce pleasing sensations in your mouth and tummy and provide positive reinforcement for what you’ve been doing and help propel you forward. Anyway, I love it (clerkship), so far, almost as much as I love bike trips and mixing metaphors.

On my first day I felt like a deer in the headlights, like I literally didn’t know anything. What is a patient chart? What does it mean to be admitted to hospital? What’s rounding (is that how your body changes in response to sleep deprivation and consequent calorie overload?) What does it mean to be on call? And when should I wear scrubs and why do doctors wear them outside the hospitals–do they just really love spreading germs around? So I’m going to try to explain some of these concepts, because we’re not really taught them in the pre-clerkship years (because we’re too busy learning e.g. that the dentatorubrothalamic tract travels in the superior cerebellar peduncle; oh B&B, I’m still bitter!)

Patient chart – OK, this one’s pretty simple; at the hospital I’m at, it’s a binder containing all the information pertaining to the patient’s current hospital admission. Including a detailed history (what brought them to hospital), progress notes (have their vital signs been stable? have they had any difficulty breathing/eating/pooping/urinating etc? do they have any other complaints?), lab results etc. The tricky part sometimes is figuring out what information to file under what tab, and this can vary depending on what the patient was admitted for. For example, someone with an eating disorder has slightly different charts that are filled out compared to someone with kidney disease, and the infants in the neonatal intensive care unit have different charts compared to those same infants when they move to the pediatrics ward. At LGH, there are different tabs for physician’s notes and progress notes; progress notes are written by nurses, who generally check on their patients every few hours, whereas physician’s notes are written by doctors and medical students after morning rounds and if there are significant changes to the patient’s condition.

Rounding – This one I still don’t quite get, to be honest. So far my understanding is that after coming to the hospital in the morning (8am start where I’m at), we look at the charts for the patients admitted by pediatricians on our ward to see what happened overnight… was the patient stable, do they have any new symptoms etc. After reviewing the chart, we’ll go talk to the patient, ask some targeted questions and perform a focused physical exam to get an idea of how they’re doing today. Then we’ll go write up a note about what we did, signing with our name and MSI3 (stands for medical student intern, year 3). I think the idea also is to come up with a plan for the patient with our attending doctor – investigations, medications, consultations, plans for discharge, and include that in the progress note, but I haven’t done much of that yet.

Now for the softer stuff… for inpatient Peds I’ve been at Lions Gate Hospital on the beautiful North Shore and it’s been swell. I’m here on Peds with one other medical student, and he’s a fantastic colleague. The call rooms are plush but have no windows; I find them too dark at night and have an incredibly difficult time waking up in the morning, to the point where I’ve considered sleeping in the resident lounge instead – yay natural light! I’m still trying to figure out the food thing… Week 1 was amazing, I brought all my food from home, but was also carrying around like 7 Tupperwares… not exactly the pinnacle of elegance (not that that’s ever been my strong suit). Week 2, things started to slightly fall off the rails… and now it’s Week 3 and I’ve only been eating cafeteria food – which is actually great but expensive – and takeout. Lots of plastic waste, more animal products than I would consider ideal… I need to get back on track with preparing food, but it’s hard and I’ve been prioritizing spending time with friends, sleep and getting exercise over eating healthy. Can’t win ’em all, at least not at the same time.

I have this new policy where I don’t check Facebook (not Facebook Messenger, just Facebook the app where I get to fuel my narcissism and feel inadequate relative to other people simultaneously) at all while on hospital grounds. I was surprised by how much that’s helped me be less anxious and more productive, and some days I even feel like I can handle adulting (that doesn’t last very long). I still check Twitter on my breaks, but I find the ratio of news to humblebragging to overly flattering selfies much more favourable.

So to sum up, so far inpatient Peds has treated me fantastic, and I’m sad it’s going to be over so soon. As a hopeful family doctor to be, I can count on two hands the number of weeks of training I have left in any one discipline, such as Peds, so I’m trying to make the most of this very limited and special time. As Annie Dillard writes… “We have less time than we knew and that time buoyant, and cloven, lucent, and missile, and wild.”

In future posts, I’ll also explain being on call, hospital admissions, the scrub thing, what a consult is, who an “attending” is and why we’re using an adjective that sounds like a verb as a noun, inpatient vs. outpatient rotations… and probably more. I’d love to hear if anyone finds any of this remotely interesting or useful (or not!), so leave a comment below…

Riding the train through northern Puget Sound, likely not far from where Annie Dillard wrote Holy the Firm. “We have less time than we knew and that time buoyant, and cloven, lucent, and missile, and wild.”

We’ve been advised not to share details of adverse clinical experiences publicly, so I won’t, but I’ll say I’m looking very forward to the day when the notion that instilling fear in students is an effective way to teach is greeted with the ridicule it deserves.

“I needed something from the world I didn’t know how to ask for. I needed people—Dave, a doctor, anyone—to deliver my feelings back to me in a form that was legible. Which is a superlative kind of empathy to seek, or to supply: an empathy that rearticulates more clearly what it’s shown.”

“A 1983 study titled “The Structure of Empathy” found a correlation between empathy and four major personality clusters: sensitivity, nonconformity, even temperedness, and social self-confidence. I like the word structure. It suggests empathy is an edifice we build like a home or office—with architecture and design, scaffolding and electricity.”

“Empathy isn’t just something that happens to us—a meteor shower of synapses firing across the brain—it’s also a choice we make: to pay attention, to extend ourselves. It’s made of exertion, that dowdier cousin of impulse. Sometimes we care for another because we know we should, or because it’s asked for, but this doesn’t make our caring hollow. The act of choosing simply means we’ve committed ourselves to a set of behaviours greater than the sum of our individual inclinations: I will listen to his sadness, even when I’m deep in my own. To say going through the motions—this isn’t reduction so much as acknowledgement of effort—the labor, the motions, the dance—of getting inside another person’s state of heart or mind.

This confession of effort chafes against the notion that empathy should always rise unbidden, that genuine means the same thing as unwilled, that intentionality is the enemy of love. But I believe in intention and I believe in work. I believe in waking up in the middle of the night and packing our bags and leaving our worst selves for our better ones.”

I thought it was impossible to screw up chana masala. TIL: this is not true, and also that certain conversations are possibly best left until after dinner.

The last batch I made involved highly overcooked chickpeas (note to self! adding baking soda before pressure cooking them really does work to decrease cooking time! almost too well – you may end up with just chickpea ghosts*), burnt fenugreek seeds that I had mistaken for mustard seeds (wrong!!! and incredibly bitter!), and almost no seasoning. Both my dinner companion and my roommate Maayan were very gracious about what was frankly a terrible dish, but I was embarrassed by my failure at something I thought I could cook in my sleep, and resolved to do better next time. Fast forward to this evening… I thought I would put in a little more effort this time, and I’m pleased with the result!

In a small saucepan, heat up a small amount of oil. Drop in mustard and coriander seeds; cook until they pop. Fry onions in a separate, large pot until translucent. Add rest of spices and Vegeta/salt to the onions; cook for a couple of minutes until blended. Transfer cooked coriander and mustard seeds to that pot. Add tomatoes and chickpeas; cook for 10 minutes at low heat. Garnish with cilantro.

* the translucent fibrous husk that envelops a chickpea. Deb Perelman of smitten kitchen makes a compelling argument that they should be removed, one chickpea at a time, to achieve ethereally smooth hummus; I agree with her